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2Reproductive Medicine, Division of Applied Health Sciences, University of Aberdeen, United Kingdom

3Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Australia

Correspondence to: B W Mol ben.mol{at}adelaide.edu.au

The indications for IVF have expanded from tubal disorders to many causes of subfertility, including unexplained. But with limited evidence underpinning its extended remit Esme Kamphuis and colleagues explain how the risks could outweigh the benefits

Since the birth of the first baby by in vitro fertilisation (IVF) in 1978, the technique has earned its reputation as a major medical breakthrough of the 20th century. IVF was developed for women with tubal disease,1 but its indications soon began to grow. In the 1990s intracytoplasmic sperm injection was developed to treat couples in which the man has poor semen quality,2 which like tubal infertility prevents sperm from coming into close proximity with an egg. In recent years, however, IVF has been applied to other types of subfertility such as mild male subfertility, endometriosis, and unexplained subfertility. The birth of many healthy children has enhanced provider and patient confidence in the safety of IVF. But does applying IVF to wider forms of infertility result in overtreatment of couples who had a reasonable chance of conceiving naturally? Is it equally effective in these conditions? And, as more is understood about the adverse health outcomes in IVF children can the risks of IVF be justified for these more liberal applications?

Rising rates of IVF

One million babies were born in the first 25 years of IVF between 1978 and 2003. It took only two more years for the tally to reach two million in 2005, with over five million estimated to have been born by the end of 2013.3 In developed countries with public health systems 2-3% of the births each year are through IVF, rising as high as 5% in Denmark and Belgium.4 This is despite the fact that an observational study showed that 95% of 350 couples planning a first pregnancy conceive …